Chronic Kidney DiseasePreserving Kidney Function

CHRONIC DISEASE SYMPOSIUM OCTOBER 2019

BABAK BARMAR MD

NEPHROLOGY

Learning Objectives

Recognizing CKD

Testing for CKD

Staging of CKD

Manage risk factors

Timely referral

Renal replacement therapy

CKD is part of primary care

Recognizing CKD

Structural abnormalities

Functional abnormalities

>3 months duration

Testing for CKD• Chem 7 to check for elevated serum creatinine

and more importantly eGFR

• Urinalysis• Urine spot protein, albumin creatinine• Urine for blood, RBC’s or casts

• Renal and bladder ultrasound

eGFR and sCr Comparison

Staging of CKD120

90

60

30

15

0

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

Symptoms of CKD- Stages I to early IV no specific symptoms

- Late stage IV and stage V:◦ Fatigue

◦ Loss of appetite, weight loss, metallic taste

◦ Decreased UOP, fluid overload, edema, SOB

◦ Mental status changes, neuropathy, asterixis

Managing Risk Factors

Modifiable risk factors

Non-modifiable risk factors◦ Race

◦ Age

◦ Family history of CKD/ESRD

Slowing CKD Progression by Managing the Modifiable Risk FactorsWeight loss and healthy lifestyle

Lower high blood pressure

Keep blood-sugar levels under control if diabetic

Smoking cessation

Reduce salt intake

Avoid NSAIDs, a type of painkillers

Moderate protein consumption

Timely Referral to NephrologyDifferent opinions

Abnormal renal function, structure or anatomy

ARF or rapid progression of CKD

Refractory HTN on 4 or more meds

Persistent electrolyte abnormalities

Recurrent or extensive nephrolithiasis

Hereditary kidney disease

Indications for RRT

Acidosis

Electrolyte abnormalities

Intoxication

Overload (fluid)

Uremia

Kidney Transplant

Summary

CKD is a very common and costly disease

CKD is a progressive disease; everyone with CKD will end up on dialysis unless they die before that

CKD is easy to diagnose with a chem 7, urine labs and a renal US

Healthy lifestyle can slow down the progression

Early referral leads to a much better and smoother transition from CKD to ESRD

Home dialysis is MUCH superior to in-center dialysis

Kidney transplant is the ultimate treatment for ESRD.

Thank you …

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